Cullen Hercules Gray

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

64044 Issued in CA

Practice address

522 S San Pedro St
Los Angeles, CA 90013

Phone

(562) 867-7999

NPI assigned

Jan 20, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cullen.graypa.p1@direct.jwch.nextgenshare.com
• Direct secure messaging: cullen.gray.p1@direct.scfhc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• JWCH Institute Inc

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1407808058
  Medicare reassignment
• South Central Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
  • NPI 1669799896
  Medicare reassignment
• JWCH Institute Inc

  • Federally Qualified Health Center (FQHC)
  • Lancaster, CA
  • NPI 1073209177
  NPD
• JWCH Institute, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bellflower, CA
  • NPI 1538342704
  NPD
• South Central Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1396891909
  NPD
• South Central Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
  • NPI 1487218970
  NPD
• Charles Drew University of Medicine & Science

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Los Angeles, CA
  • NPI 1609367788
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1674172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1487369799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90013",
            "telephone_number": "562-867-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "CULLEN",
        "middle_name": "HERCULES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-20",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "64044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Gray
• Ashley Nicole Gray, M.D., M.S.
• Carrie Ann Gray, LCSW
• Cecilia Patricia Gray, CLINICAL NURSE SPECI
• Colby Earl Gray, BA
• D'Arcy Catherine Gray
• Darien Gray, DPT
• Edison Gray
• Enajia Gray
• Eric Lee Gray

• Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.